Monitoring Intrarenal Pressure vs. Irrigation Fluid Absorption for Infection Prevention in Ureteroscopy

As ureteroscopy (URS) is increasingly utilized, preventing and managing severe postoperative infections-such as urosepsis-has become a clinical priority. Elevated intrarenal pressure (IRP) and irrigation fluid absorption (IFA) represent two core pathophysiological steps in the translocation of bacteria and endotoxins into the bloodstream. This review compares the clinical utility and technological maturity of IRP and IFA monitoring during URS. The analysis indicates that IRP is the instantaneous physical driving force for pyelovenous backflow, whereas IFA is the integrated outcome of multidimensional variables, including the pressure gradient, operative time and tissue permeability. Consequently, monitoring a single dimension may be insufficient to comprehensively assess infection risk. IRP monitoring (e.g., using a ureteral access sheath with a pressure-sensing channel or a flexible URS with an integrated pressure sensor) offers the advantage of real-time feedback, potentially playing a key role in maintaining low IRP and proactively preventing intrarenal backflow. However, it cannot account for the cumulative effect of time or changes in tissue permeability. IFA monitoring, despite its inherent lag, may provide a more comprehensive quantitative measure of the pathogenic load absorbed by the patient, suggesting potential predictive and warning value for the occurrence of infection; however, clinically validated thresholds and prospective evidence are currently lacking. In the future, with advancements in monitoring technology, the development of automated closed-loop systems integrating high-precision IRP monitoring, real-time IFA monitoring, intelligent irrigation and negative pressure suction holds promise for maximizing the balance between surgical efficacy and patient safety, provided that future studies can establish evidence-based intervention triggers.